Infant mortawity refers to deads of young chiwdren, typicawwy dose wess dan one year of age. It is measured by de infant mortawity rate (IMR), which is de number of deads of chiwdren under one year of age per 1000 wive birds. The under-five mortawity rate is awso an important statistic, considering de infant mortawity rate focuses onwy on chiwdren under one year of age.[1]

Premature birf is de biggest contributor to de IMR.[2] Oder weading causes of infant mortawity are birf asphyxia, pneumonia, term birf compwications such as abnormaw presentation of de foetus umbiwicaw cord prowapse, or prowonged wabor,[3]neonataw infection, diarrhea, mawaria, measwes and mawnutrition, uh-hah-hah-hah.[4] One of de most common preventabwe causes of infant mortawity is smoking during pregnancy.[5] Many factors contribute to infant mortawity, such as de moder's wevew of education, environmentaw conditions, and powiticaw and medicaw infrastructure.[6] Improving sanitation, access to cwean drinking water, immunization against infectious diseases, and oder pubwic heawf measures can hewp reduce high rates of infant mortawity.

Chiwd mortawity is de deaf of a chiwd before de chiwd's fiff birdday, measured as de under-5 chiwd mortawity rate (U5MR). Nationaw statistics sometimes group dese two mortawity rates togeder. Gwobawwy, 9.2 miwwion chiwdren die each year before deir fiff birdday; more dan 60% of dese deads are seen as being avoidabwe wif wow-cost measures such as continuous breast-feeding, vaccinations and improved nutrition, uh-hah-hah-hah.[7]

Throughout de worwd, infant mortawity rate (IMR) fwuctuates drasticawwy, and according to Biotechnowogy and Heawf Sciences, education and wife expectancy in de country is de weading indicator of IMR.[9] This study was conducted across 135 countries over de course of 11 years wif Africa having de highest infant mortawity rate of any oder region studied wif 68 deads per 1,000 wive birds.

Infant mortawity rate (IMR) is de number of deads per 1,000 wive birds of chiwdren under one year of age. The rate for a given region is de number of chiwdren dying under one year of age, divided by de number of wive birds during de year, muwtipwied by 1,000.[10]

Forms of infant mortawity:

Perinataw mortawity is wate fetaw deaf (22 weeks gestation to birf), or deaf of a newborn up to one week postpartum.[10]

Neonataw mortawity is newborn deaf occurring widin 28 days postpartum. Neonataw deaf is often attributed to inadeqwate access to basic medicaw care, during pregnancy and after dewivery. This accounts for 40–60% of infant mortawity in devewoping countries.[11]

Postneonataw mortawity is de deaf of chiwdren aged 29 days to one year. The major contributors to postneonataw deaf are mawnutrition, infectious disease, troubwed pregnancy, Sudden Infant Deaf Syndrome and probwems wif de home environment.[12]

Low birf weight makes up 60–80% of de infant mortawity rate in devewoping countries. The New Engwand Journaw of Medicine stated dat "The wowest mortawity rates occur among infants weighing 3,000 to 3,500 g (6.6 to 7.7 wb). For infants born weighing 2,500 g (5.5 wb) or wess, de mortawity rate rapidwy increases wif decreasing weight, and most of de infants weighing 1,000 g (2.2 wb) or wess die. As compared wif normaw-birf-weight infants, dose wif wow weight at birf are awmost 40 times more wikewy to die in de neonataw period; for infants wif very wow weight at birf de rewative risk of neonataw deaf is awmost 200 times greater." Infant mortawity due to wow birf weight is usuawwy a direct cause stemming from oder medicaw compwications such as preterm birf, poor maternaw nutritionaw status, wack of prenataw care, maternaw sickness during pregnancy, and an unhygienic home environments.[10] Awong wif birf weight, period of gestation makes up de two most important predictors of an infant's chances of survivaw and deir overaww heawf.[16]

According to de New Engwand Journaw of Medicine, "in de past two decades, de infant mortawity rate (deads under one year of age per dousand wive birds) in de United States has decwined sharpwy." Low birf weights from African American moders remain twice as high as dat of white women, uh-hah-hah-hah. LBW may be de weading cause of infant deads, and it is greatwy preventabwe. Awdough it is preventabwe, de sowutions may not be de easiest but effective programs to hewp prevent LBW are a combination of heawf care, education, environment, mentaw modification and pubwic powicy, infwuencing a cuwture supporting wifestywe.[17] Preterm birf is de weading cause of newborn deads worwdwide.[18] Even dough America excews past many oder countries in de care and saving of premature infants, de percentage of American woman who dewiver prematurewy is comparabwe to dose in devewoping countries. Reasons for dis incwude teenage pregnancy, increase in pregnant moders over de age of dirty-five, increase in de use of in-vitro fertiwization which increases de risk of muwtipwe birds, obesity and diabetes. Awso, women who do not have access to heawf care are wess wikewy to visit a doctor, derefore increasing deir risk of dewivering prematurewy.[19]

Thousands of infant deads per year are cwassified as sudden infant deaf syndrome (SIDS). According to de Mayo Cwinic, SIDS is de unexpwained deaf, usuawwy during sweep, of a seemingwy heawdy baby. Awdough de direct cause of SIDS remains unknown, many doctors bewieve dat dere are severaw factors dat put babies at an increased risk of SIDS, incwuding: babies sweeping on deir stomachs, exposure to cigarette smoke in de womb or after birf, sweeping in bed wif parents, premature birf, being a twin or tripwet, being born to a teen moder, and awso wiving in poverty settings. Awdough de cause is unknown and currentwy cannot be expwained, doctors have come to de concwusion dat SIDS is most wikewy to occur between 2 and 4 monds and most deads occur in de winter time. Recommended precautions incwude ensuring dat infants sweep on deir backs, controwwing de temperature of de bedroom, empwoying a crib widout toys or excess bedding, and breastfeeding.[20]

Mawnutrition freqwentwy accompanies dese[which?] diseases, and is a primary factor contributing to de compwications of bof diarrhea and pneumonia, awdough de causaw winks and mechanisms remain uncwear. Factors oder nutrition awso infwuence de incidence of diarrhea, incwuding socioeconomic status, disruption of traditionaw wifestywes, access to cwean water and sanitation faciwities, age and breastfeeding status.

Protein energy mawnutrition and micronutrient deficiency are two reasons for stunted growf in chiwdren under five years owd in de weast devewoped countries. Mawnutrition weads to diarrhea and dehydration, and uwtimatewy deaf. Miwwions of women in devewoping countries are stunted due to a history of chiwdhood mawnutrition, uh-hah-hah-hah. Women's bodies are dus underdevewoped, and deir chances of surviving chiwdbirf decrease. Due to underdevewoped bodies, de probabiwity of an obstructed pregnancy increases. Protein-energy deficiency resuwts in wow-qwawity breastmiwk dat provides wess energy and oder nutrition, uh-hah-hah-hah.[10]

Vitamin A deficiency can wead to stunted growf, bwindness, and increased mortawity due to de wack of nutrients in de body. Two hundred and fifty miwwion infants are affected by Vitamin A deficiency. Among women in devewoping countries, 40% have iron deficiency anemia, which increases maternaw and infant mortawity rates, chances of stiwwbirf, cases of wow birf weight babies, premature dewivery, and probabiwity of fetaw brain damage.[10] One way to prevent Vitamin A deficiency is to educate de moder on de many benefits of breastfeeding. Breastmiwk is a naturaw source of Vitamin A, and suppwies de suckwing infant wif enough Vitamin A.[21]

Babies born in wow to middwe income countries in sub-Saharan Africa and soudern Asia are at de highest risk of neonataw deaf. Bacteriaw infections of de bwoodstream, wungs, and de brain's covering (meningitis) are responsibwe for 25% of neonataw deads. Newborns can acqwire infections during birf from bacteria dat are present in deir moder's reproductive tract. The moder may not be aware of de infection, or she may have an untreated pewvic infwammatory disease or sexuawwy transmitted disease. These bacteria can move up de vaginaw canaw into de amniotic sac surrounding de baby. Maternaw bwood-borne infection is anoder route of bacteriaw infection from moder to baby. Neonataw infection is awso more wikewy wif de premature rupture of de membranes (PROM) of de amniotic sac.[22]

Seven out of ten chiwdhood deads are due to infectious diseases: acute respiratory infection, diarrhea, measwes, and mawaria. Acute respiratory infection such as pneumonia, bronchitis, and bronchiowitis account for 30% of chiwdhood deads; 95% of pneumonia cases occur in de devewoping worwd. Diarrhea is de second-wargest cause of chiwdhood mortawity in de worwd, whiwe mawaria causes 11% of chiwdhood deads. Measwes is de fiff-wargest cause of chiwdhood mortawity.[10][23]Fowic acid for moders is one way to combat iron deficiency. A few pubwic heawf measures used to wower wevews of iron deficiency anemia incwude iodize sawt or drinking water, and incwude vitamin A and muwtivitamin suppwements into a moder's diet.[10] A deficiency of dis vitamin causes certain types of anemia (wow red bwood ceww count).[24]

Infant mortawity rate can be a measure of a nation's heawf and sociaw condition, uh-hah-hah-hah.[16][25] It is a composite of a number of component rates which have deir separate rewationship wif various sociaw factors and can often be seen as an indicator to measure de wevew of socioeconomic disparity widin a country.[25]

Organic water powwution is a better indicator of infant mortawity dan heawf expenditures per capita. Water contaminated wif various padogens houses a host of parasitic and microbiaw infections. Infectious disease and parasites are carried via water powwution from animaw wastes.[26] Areas of wow socioeconomic status are more prone to inadeqwate pwumbing infrastructure, and poorwy maintained faciwities.[10] The burning of inefficient fuews doubwes de rate of chiwdren under 5 years owd wif acute respiratory tract infections.[10] Cwimate and geography often pway a rowe in sanitation conditions. For exampwe, de inaccessibiwity of cwean water exacerbates poor sanitation conditions.[26]

Peopwe who wive in areas where particuwate matter (PM) air powwution is higher tend to have more heawf probwems across de board. Short-term and wong-term effects of ambient air powwution are associated wif an increased mortawity rate, incwuding infant mortawity. Air powwution is consistentwy associated wif post neonataw mortawity due to respiratory effects and sudden infant deaf syndrome. Specificawwy, air powwution is highwy associated wif SIDs in de United States during de post-neonataw stage.[27] High infant mortawity is exacerbated because newborns are a vuwnerabwe subgroup dat is affected by air powwution, uh-hah-hah-hah.[28] Newborns who were born into dese environments are no exception, uh-hah-hah-hah. Women who are exposed to greater air powwution on a daiwy basis who are pregnant shouwd be cwosewy watched by deir doctors, as weww as after de baby is born, uh-hah-hah-hah. Babies who wive in areas wif wess air powwution have a greater chance of wiving untiw deir first birdday. As expected, babies who wive in environments wif more air powwution are at greater risk for infant mortawity. Areas dat have higher air powwution awso have a greater chance of having a higher popuwation density, higher crime rates and wower income wevews, aww of which can wead to higher infant mortawity rates.[29]

The key powwutant for infant mortawity rates is carbon monoxide. Carbon monoxide is a coworwess, odorwess gas dat does great harm especiawwy to infants because of deir immature respiratory system.[30] Anoder major powwutant is second-hand smoke, which is a powwutant dat can have detrimentaw effects on a fetus. According to de American Journaw of Pubwic Heawf, "in 2006, more dan 42 000 Americans died of second hand smoke-attributabwe diseases, incwuding more dan 41 000 aduwts and nearwy 900 infants ... fuwwy 36% of de infants who died of wow birf weight caused by exposure to maternaw smoking in utero were Bwacks, as were 28% of dose dying of respiratory distress syndrome, 25% dying of oder respiratory conditions, and 24% dying of sudden infant deaf syndrome." The American Journaw of Epidemiowogy awso stated dat "Compared wif nonsmoking women having deir first birf, women who smoked wess dan one pack of cigarettes per day had a 25% greater risk of mortawity, and dose who smoked one or more packs per day had a 56% greater risk. Among women having deir second or higher birf, smokers experienced 30% greater mortawity dan nonsmokers."

Modern research in de United States on raciaw disparities in infant mortawity suggests a wink between de institutionawized racism dat pervades de environment and high rates of African American infant mortawity. In syndesis of dis research, it has been observed dat "African American infant mortawity remains ewevated due to de sociaw arrangements dat exist between groups and de wifewong experiences responding to de resuwtant power dynamics of dese arrangements."[15]

It is important to note dat infant mortawity rates do not decwine among African Americans even if deir socio-economic status does improve. Parker Dominguez at de University of Soudern Cawifornia has made some headway in determining de reasoning behind dis, cwaiming bwack women are more prone to psychowogicaw stress dan oder women of different races in de United States. Stress is a wead factor in inducing wabor in pregnant women, and derefore high wevews of stress during pregnancy couwd wead to premature birds dat have de potentiaw to be fataw for de infant.[31]

Sociaw cwass is a major factor in infant mortawity, bof historicawwy and today. Between 1912 and 1915, de Chiwdren's Bureau in de United States examined data across eight cities and nearwy 23,000 wive birds. They discovered dat wower incomes tend to correwate wif higher infant mortawity. In cases where de fader had no income, de rate of infant mortawity was 357% more dan dat for de highest income earners ($1,250+). Differences between races were awso apparent. African-American moders experience infant mortawity at a rate 44% higher dan average;[32] however, research indicates dat socio-economic factors do not totawwy account for de raciaw disparities in infant mortawity.[15]

Whiwe infant mortawity is normawwy negativewy correwated wif GDP, dere may indeed be some opposing short-term effects from a recession, uh-hah-hah-hah. A recent study by The Economist showed dat economic swowdowns reduce de amount of air powwution, which resuwts in a wower infant mortawity rate. In de wate 1970s and earwy 1980s, de recession's impact on air qwawity is estimated to have saved around 1,300 US babies.[33] It is onwy during deep recessions dat infant mortawity increases. According to Norbert Schady and Marc-François Smitz, recessions when GDP per capita drops by 15% or more increase infant mortawity.[34]

Sociaw cwass dictates which medicaw services are avaiwabwe to an individuaw. Disparities due to socioeconomic factors have been exacerbated by advances in medicaw technowogy. Devewoped countries, most notabwy de United States, have seen a divergence between dose wiving in poverty who cannot afford medicaw advanced resources, weading to an increased chance of infant mortawity, and oders.[25]

In most cases, war-affected areas wiww experience a significant increase in infant mortawity rates. Having a war taking pwace where a woman is pwanning on having a baby is not onwy stressfuw on de moder and foetus, but awso has severaw detrimentaw effects.

However, many oder significant factors infwuence infant mortawity rates in war-torn areas. Heawf care systems in devewoping countries in de midst of war often cowwapse. Attaining basic medicaw suppwies and care becomes increasingwy difficuwt. During de Yugoswav Wars in de 1990s Bosnia experienced a 60% decrease in chiwd immunizations. Preventabwe diseases can qwickwy become epidemic given de medicaw conditions during war.[36]

Many devewoping countries rewy on foreign aid for basic nutrition, uh-hah-hah-hah. Transport of aid becomes significantwy more difficuwt in times of war. In most situations de average weight of a popuwation wiww drop substantiawwy.[37] Expecting moders are affected even more by wack of access to food and water. During de Yugoswav Wars in Bosnia de number of premature babies born increased and de average birf weight decreased.[36]

There have been severaw instances in recent years of systematic rape as a weapon of war. Women who become pregnant as a resuwt of war rape face even more significant chawwenges in bearing a heawdy chiwd. Studies suggest dat women who experience sexuaw viowence before or during pregnancy are more wikewy to experience infant deaf in deir chiwdren, uh-hah-hah-hah.[38][39][40] Causes of infant mortawity in abused women range from physicaw side effects of de initiaw trauma to psychowogicaw effects dat wead to poor adjustment to society. Many women who became pregnant by rape in Bosnia were isowated from deir hometowns making wife after chiwdbirf exponentiawwy more difficuwt.[41]

Devewoping countries have a wack of access to affordabwe and professionaw heawf care resources, and skiwwed personnew during dewiveries.[10][35] Countries wif histories of extreme poverty awso have a pattern of epidemics, endemic infectious diseases, and wow wevews of access to maternaw and chiwd heawdcare.[42]

Powiticaw modernization perspective, de neo-cwassicaw economic deory dat scarce goods are most effectivewy distributed to de market, say dat de wevew of powiticaw democracy infwuences de rate of infant mortawity. Devewoping nations wif democratic governments tend to be more responsive to pubwic opinion, sociaw movements, and speciaw interest groups for issues wike infant mortawity. In contrast, non-democratic governments are more interested in corporate issues and wess so in heawf issues. Democratic status effects de dependency a nation has towards its economic state via export, investments from muwtinationaw corporations and internationaw wending institutions.[42]

Levews of socioeconomic devewopment and gwobaw integration are inversewy rewated to a nation's infant mortawity rate.[10][44] Dependency perspective occurs in a gwobaw capitaw system. A nation's internaw impact is highwy infwuenced by its position in de gwobaw economy and has adverse effects on de survivaw of chiwdren in devewoping countries.[26] Countries can experience disproportionate effects from its trade and stratification widin de gwobaw system.[45] It aids in de gwobaw division of wabor, distorting de domestic economy of devewoping nations. The dependency of devewoping nations can wead to a reduce rate of economic growf, increase income ineqwawity inter- and intra-nationaw, and adversewy affects de wewwbeing of a nation's popuwation, uh-hah-hah-hah. A cowwective cooperation between economic countries pways a rowe in devewopment powicies in de poorer, peripheraw, countries of de worwd.[42]

These economic factors present chawwenges to governments' pubwic heawf powicies.[26] If de nation's abiwity to raise its own revenues is compromised, governments wiww wose funding for its heawf service programs, incwuding services dat aim in decreasing infant mortawity rates.[42] Peripheraw countries face higher wevews of vuwnerabiwity to de possibwe negative effects of gwobawization and trade in rewation to key countries in de gwobaw market.[26]

Even wif a strong economy and economic growf (measured by a country's gross nationaw product), de advances of medicaw technowogies may not be fewt by everyone, wending itsewf to increasing sociaw disparities.[25]

High rates of infant mortawity occur in devewoping countries where financiaw and materiaw resources are scarce and dere is a high towerance to high number of infant deads. There are circumstances where a number of devewoping countries to breed a cuwture where situations of infant mortawity such as favoring mawe babies over femawe babies are de norm.[10] In devewoping countries such as Braziw, infant mortawity rates are commonwy not recorded due to faiwure to register for deaf certificates.[46] Faiwure to register is mainwy due to de potentiaw woss of time and money and oder indirect costs to de famiwy.[46] Even wif resource opportunities such as de 1973 Pubwic Registry Law 6015, which awwowed free registration for wow-income famiwies, de reqwirements to qwawify howd back individuaws who are not contracted workers.[46]

Anoder cuwturaw reason for infant mortawity, such as what is happening in Ghana, is dat "besides de obvious, wike rutted roads, dere are prejudices against wives or newborns weaving de house."[47] Because of dis it is making it even more difficuwt for de women and newborns to get de treatment dat is avaiwabwe to dem and dat is needed.

Cuwturaw infwuences and wifestywe habits in de United States can account for some deads in infants droughout de years. According to de Journaw of de American Medicaw Association "de post neonataw mortawity risk (28 to 364 days) was highest among continentaw Puerto Ricans" compared to babies of de non-Hispanic race. Exampwes of dis incwude teenage pregnancy, obesity, diabetes and smoking. Aww are possibwe causes of premature birds, which constitute de second highest cause of infant mortawity.[19] Ednic differences experienced in de United States are accompanied by higher prevawence of behavioraw risk factors and sociodemographic chawwenges dat each ednic group faces.[16]

Historicawwy, mawes have had higher infant mortawity rates dan femawes. The difference between mawe and femawe infant mortawity rates have been dependent on environmentaw, sociaw, and economic conditions. More specificawwy, mawes are biowogicawwy more vuwnerabwe to infections and conditions associated wif prematurity and devewopment. Before 1970, de reasons for mawe infant mortawity were due to infections, and chronic degenerative diseases. However, since 1970, certain cuwtures emphasizing mawes has wed to a decrease in de infant mortawity gap between mawes and femawes. Awso, medicaw advances have resuwted in a growing number of mawe infants surviving at higher rates dan femawes due to de initiaw high infant mortawity rate of mawes.[48]

Genetic components resuwts in newborn femawes being biowogicawwy advantaged when it comes to surviving deir first birdday. Mawes, biowogicawwy, have wower chances of surviving infancy in comparison to femawe babies. As infant mortawity rates saw a decrease on a gwobaw scawe, de gender most affected by infant mortawity changed from mawes experiences a biowogicaw disadvantage, to femawes facing a societaw disadvantage.[48] Some devewoping nations have sociaw and cuwturaw patterns dat refwects aduwt discrimination to favor boys over girws for deir future potentiaw to contribute to de househowd production wevew. A country's ednic composition, homogeneous versus heterogeneous, can expwain sociaw attitudes and practices. Heterogeneous wevew is a strong predictor in expwaining infant mortawity.[44]

Birf spacing is de time between birds. Birds spaced at weast dree years apart from one anoder are associated wif de wowest rate of mortawity. The wonger de intervaw between birds, de wower de risk for having any birding compwications, and infant, chiwdhood and maternaw mortawity.[11][49] Higher rates of pre-term birds, and wow birf weight are associated wif birf to conception intervaws of wess dan six monds and abortion to pregnancy intervaw of wess dan six monds. Shorter intervaws between birds increase de chances of chronic and generaw under-nutrition; 57% of women in 55 devewoping countries reported birf spaces shorter dan dree years; 26% report birf spacing of wess dan two years. Onwy 20% of post-partum women report wanting anoder birf widin two years; however, onwy 40% are taking necessary steps such as famiwy pwanning to achieve de birf intervaws dey want.[11]

Unpwanned pregnancies and birf intervaws of wess dan twenty-four monds are known to correwate wif wow birf weights and dewivery compwications. Awso, women who are awready smaww in stature tend to dewiver smawwer dan average babies, perpetuating a cycwe of being underweight.[10][11][49]

The moder's educationaw attainment and witeracy are correwated wif age of first pregnancy, and probabiwity dat de moder attain prenataw and postnataw care. Moders wif a secondary education have a higher probabiwity of waiting untiw a water age to get pregnant. Once pregnant, dey are awso more wikewy to get prenataw and postnataw care, and dewiver deir chiwd in de presence of a skiwwed attendant. Women who finish at weast a primary-wevew education have improved nutrition, medicaw care, information access, and economic independence. Infants reap benefits such as heawdy environments, improved nutrition, and medicaw care. Moders wif some wevew of education have a higher probabiwity to breastfeeding.[10][26][44] The duration of breastfeeding has de potentiaw to infwuence de birf space.[49] Women widout any educationaw background tend to have chiwdren at an earwier age, dus deir bodies are not yet mature enough to carry and dewiver a chiwd.[10]

Miwwennium Devewopment Goaws were created to improve de heawf and weww being of peopwe worwdwide. Its fourf goaw is to decrease de number of mortawities widin de infant and chiwdhood popuwation by two dirds, a decrease from 95 to 31 deads per 1000.[10] Countries swow to abide by de Miwwennium Devewopment Goaw by 2015 are projected to have difficuwty in reaching goaw four.[35]

Reductions in infant mortawity are possibwe in any stage of a country's devewopment.[14] Rate reductions are evidence dat a country is advancing in human knowwedge, sociaw institutions and physicaw capitaw. Governments can reduce de mortawity rates by addressing de combined need for education (such as universaw primary education), nutrition, and access to basic maternaw and infant heawf services. A powicy focus has de potentiaw to aid dose most at risk for infant and chiwdhood mortawity awwows ruraw, poor and migrant popuwations.[35]

Reducing chances of babies being born at wow birf weights and contracting pneumonia can be accompwished by improving air qwawity. Improving hygiene can prevent infant mortawity. Home-based technowogy to chworinate, fiwter, and sowar disinfection for organic water powwution couwd reduce cases of diarrhea in chiwdren by up to 48%.[10][23][26] Improvements in food suppwies and sanitation has been shown to work in de United States' most vuwnerabwe popuwations, one being African Americans. Overaww, women's heawf status need to remain high.[25]

Simpwe behavioraw changes, such as hand washing wif soap, can significantwy reduce de rate of infant mortawity from respiratory and diarrheaw diseases.[50] According to UNICEF, hand washing wif soap before eating and after using de toiwet can save more wives of chiwdren dan any singwe vaccine or medicaw intervention, by cutting deads from diarrhea and acute respiratory infections.[51]

Future probwems for moders and babies can be prevented. It is important dat women of reproductive age adopt heawdy behaviors in everyday wife, such as taking fowic acid, maintaining a heawdy diet and weight, being physicawwy active, avoiding tobacco use, and avoiding excessive awcohow and drug use. If women fowwow some of de above guidewines, water compwications can be prevented to hewp decrease de infant mortawity rates. Attending reguwar prenataw care check-ups wiww hewp improve de baby's chances of being dewivered in safer conditions and surviving.

Focusing on preventing preterm and wow birf weight dewiveries droughout aww popuwations can hewp to ewiminate cases of infant mortawity and decrease heawf care disparities widin communities. In de United States, dese two goaws have decreased infant mortawity rates on a regionaw popuwation, it has yet to see furder progress on a nationaw wevew.[16]

Technowogicaw advances in medicine wouwd decrease de infant mortawity rate and an increased access to such technowogies couwd decrease raciaw and ednic disparities. It has been shown dat technowogicaw determinants are infwuenced by sociaw determinants. Those who cannot afford to utiwize advances in medicine tend to show higher rates of infant mortawity. Technowogicaw advances has, in a way, contributed to de sociaw disparities observed today. Providing eqwaw access has de potentiaw to decrease socioeconomic disparities in infant mortawity.[25] Specificawwy, Cambodia is facing issues wif a disease dat is unfortunatewy kiwwing infants. The symptoms onwy wast 24 hours and de resuwt is deaf. As stated if technowogicaw advances were increased in countries it wouwd make it easier to find de sowution to diseases such as dis.[52] Recentwy, dere have been decwines in de United States dat couwd be attributed to advances in technowogy. Advancements in de Neonataw Intensive Care Unit can be rewated to de decwine in infant mortawity in addition to de advancement of surfactants.[53] However, de importance of de advancement of technowogy remains uncwear as de number of high-risk birds increases in de United States.[53]

Educated femawes practice a heawdier wifestywe. The more educated a woman is de more wikewy she is to seek out care, give birf in de presence of a skiwwed attendant, breastfeed, and understand de conseqwences of HIV/AIDS.[10] Improving women's heawf and sociaw status is one way to amewiorate infant mortawity.[11] Status shouwd rise for femawes seeking out education, uh-hah-hah-hah.[44] Providing women access to famiwy pwanning centers can educate moders on how to pwan ahead for deir famiwies. Educationaw means can awso teach moders on de beneficiaw heawf practices such as breastfeeding. Government recognizing birf space as a possibwe heawf intervention is now working towards making affordabwe contraception avaiwabwe.[49]

Granting women empwoyment raises deir status and autonomy. Having a gainfuw empwoyment can raise de perceived worf of femawes. This can wead to an increase in de number of women getting an education and a decrease in de number of femawe infanticide.[44] In de sociaw modernization perspective, education weads to devewopment. Higher number of skiwwed workers means more earning and furder economic growf. According to de economic modernization perspective, dis is one type economic growf viewed as de driving force behind de increase in devewopment and standard of wiving in a country. This is furder expwained by de modernization deory- economic devewopment promotes physicaw wewwbeing. As economy rises, so do technowogicaw advances and dus, medicaw advances in access to cwean water, heawf care faciwities, education, and diet. These changes may decrease infant mortawity.[42][44]

Economicawwy, governments couwd reduce infant mortawity by buiwding and strengdening capacity in human resources. Increasing human resources such as physicians, nurses, and oder heawf professionaws wiww increase de number of skiwwed attendants and de number of peopwe abwe to give out immunized against diseases such as measwes. Increasing de number of skiwwed professionaws is negativewy correwated wif maternaw, infant, and chiwdhood mortawity. Between 1960 and 2000, de infant mortawity rate decreased by hawf as de number of physicians increased by four fowds.[35] Wif de addition of one physician to every 1000 persons in a popuwation, infant mortawity wiww reduce by 30%.

In certain parts of de U.S., specific modern programs aim to reduce wevews of infant mortawity. An exampwe of one such program is de 'Heawdy Me, Heawdy You' program based in Nordeast Texas. It intends to identify factors dat contribute to negative birf outcomes droughout a 37-county area.[54] An additionaw program dat aims to reduce infant mortawity is de "Best Babies Zone" (BBZ) based at de University of Cawifornia, Berkewey. The BBZ uses de wife course approach to address de structuraw causes of poor birf outcomes and toxic stress in dree U.S. neighborhoods. By empwoying community-generated sowutions, de Best Babies Zone's uwtimate goaw is to achieve heawf eqwity in communities dat are disproportionatewy impacted by infant deaf.[55]

The infant mortawity rate correwates very strongwy wif, and is among de best predictors of, state faiwure.[cwarification needed][57] IMR is derefore awso a usefuw indicator of a country's wevew of heawf or devewopment, and is a component of de physicaw qwawity of wife index.

However, de medod of cawcuwating IMR often varies widewy between countries, and is based on how dey define a wive birf and how many premature infants are born in de country. Reporting of infant mortawity rates can be inconsistent, and may be understated, depending on a nation's wive birf criterion, vitaw registration system, and reporting practices.[58] The reported IMR provides one statistic which refwects de standard of wiving in each nation, uh-hah-hah-hah. Changes in de infant mortawity rate refwect sociaw and technicaw capacities[cwarification needed] of a nation's popuwation, uh-hah-hah-hah.[14] The Worwd Heawf Organization (WHO) defines a wive birf as any infant born demonstrating independent signs of wife, incwuding breading, heartbeat, umbiwicaw cord puwsation or definite movement of vowuntary muscwes.[59] This definition is used in Austria, for exampwe.[60] The WHO definition is awso used in Germany, but wif one swight modification: muscwe movement is not considered to be a sign of wife.[61] Many countries, however, incwuding certain European states (e.g. France) and Japan, onwy count as wive birds cases where an infant breades at birf, which makes deir reported IMR numbers somewhat wower and increases deir rates of perinataw mortawity.[62] In de Czech Repubwic and Buwgaria, for instance, reqwirements for wive birf are even higher.[63]

Awdough many countries have vitaw registration systems and certain reporting practices, dere are many inaccuracies, particuwarwy in undevewoped nations, in de statistics of de number of infants dying. Studies have shown dat comparing dree information sources (officiaw registries, househowd surveys, and popuwar reporters) dat de "popuwar deaf reporters" are de most accurate. Popuwar deaf reporters incwude midwives, gravediggers, coffin buiwders, priests, and oders—essentiawwy peopwe who knew de most about de chiwd's deaf. In devewoping nations, access to vitaw registries, and oder government-run systems which record birds and deads, is difficuwt for poor famiwies for severaw reasons. These struggwes force stress on famiwies[cwarification needed], and make dem take drastic measures[cwarification needed] in unofficiaw deaf ceremonies for deir deceased infants. As a resuwt, government statistics wiww inaccuratewy refwect a nation's infant mortawity rate. Popuwar deaf reporters have first-hand information, and provided dis information can be cowwected and cowwated, can provide rewiabwe data which provide a nation wif accurate deaf counts and meaningfuw causes of deads dat can be measured/studied.[46]

UNICEF uses a statisticaw medodowogy to account for reporting differences among countries:

UNICEF compiwes infant mortawity country estimates derived from aww sources and medods of estimation obtained eider from standard reports, direct estimation from micro data sets, or from UNICEF's yearwy exercise. In order to sort out differences between estimates produced from different sources, wif different medods, UNICEF devewoped, in coordination wif WHO, de WB and UNSD, an estimation medodowogy dat minimizes de errors embodied in each estimate and harmonize trends awong time. Since de estimates are not necessariwy de exact vawues used as input for de modew, dey are often not recognized as de officiaw IMR estimates used at de country wevew. However, as mentioned before, dese estimates minimize errors and maximize de consistency of trends awong time.[64]

Anoder chawwenge to comparabiwity is de practice of counting fraiw or premature infants who die before de normaw due date as miscarriages (spontaneous abortions) or dose who die during or immediatewy after chiwdbirf as stiwwborn. Therefore, de qwawity of a country's documentation of perinataw mortawity can matter greatwy to de accuracy of its infant mortawity statistics. This point is reinforced by de demographer Answey Coawe, who finds dubiouswy high ratios of reported stiwwbirds to infant deads in Hong Kong and Japan in de first 24 hours after birf, a pattern dat is consistent wif de high recorded sex ratios at birf in dose countries. It suggests not onwy dat many femawe infants who die in de first 24 hours are misreported as stiwwbirds rader dan infant deads, but awso dat dose countries do not fowwow WHO recommendations for de reporting of wive birds and infant deads.[65]

Anoder seemingwy paradoxicaw finding, is dat when countries wif poor medicaw services introduce new medicaw centers and services, instead of decwining, de reported IMRs often increase for a time. This is mainwy because improvement in access to medicaw care is often accompanied by improvement in de registration of birds and deads. Deads dat might have occurred in a remote or ruraw area, and not been reported to de government, might now be reported by de new medicaw personnew or faciwities. Thus, even if de new heawf services reduce de actuaw IMR, de reported IMR may increase.

Cowwecting de accurate statistics of infant mortawity rate couwd be an issue in some ruraw communities in devewoping countries. In dose communities, some oder awternative medods for cawcuwating infant mortawity rate are emerged, for exampwe, popuwar deaf reporting and househowd survey.[46] The country-to-country variation in chiwd mortawity rates is huge, and growing wider despite de progress. Among de worwd's roughwy 200 nations, onwy Somawia showed no decrease in de under-5 mortawity rate over de past two decades.The wowest rate in 2011 was in Singapore, which had 2.6 deads of chiwdren under age 5 per 1,000 wive birds. The highest was in Sierra Leone, which had 185 chiwd deads per 1,000 birds. The gwobaw rate is 51 deads per 1,000 birds. For de United States, de rate is eight per 1,000 birds.[66]

Infant mortawity rate (IMR) is not onwy a group of statistic but instead it is a refwection of de socioeconomic devewopment and effectivewy represents de presence of medicaw services in de countries. IMR is an effective resource for de heawf department to make decision on medicaw resources reawwocation, uh-hah-hah-hah. IMR awso formuwates de gwobaw heawf strategies and hewp evawuate de program success. The existence of IMR hewps sowve de inadeqwacies of de oder vitaw statistic systems for gwobaw heawf as most of de vitaw statistic systems usuawwy negwect de infant mortawity statistic number from de poor. There are certain amounts of unrecorded infant deads in de ruraw area as dey do not have information about infant mortawity rate statistic or do not have de concept about reporting earwy infant deaf.[46]

The excwusion of any high-risk infants from de denominator or numerator in reported IMRs can cause probwems in making comparisons. Many countries, incwuding de United States, Sweden and Germany, count an infant exhibiting any sign of wife as awive, no matter de monf of gestation or de size, but according to United States some oder countries differ in dese practices. Aww of de countries named adopted de WHO definitions in de wate 1980s or earwy 1990s,[67] which are used droughout de European Union, uh-hah-hah-hah.[68] However, in 2009, de US CDC issued a report dat stated dat de American rates of infant mortawity were affected by de United States' high rates of premature babies compared to European countries. It awso outwined de differences in reporting reqwirements between de United States and Europe, noting dat France, de Czech Repubwic, Irewand, de Nederwands, and Powand do not report aww wive birds of babies under 500 g and/or 22 weeks of gestation, uh-hah-hah-hah.[69][70][71] However, de differences in reporting are unwikewy to be de primary expwanation for de United States' rewativewy wow internationaw ranking. Rader, de report concwuded dat primary reason for de United States’ higher infant mortawity rate when compared wif Europe was de United States’ much higher percentage of preterm birds.[72]

Untiw de 1990s, Russia and de Soviet Union did not count, as a wive birf or as an infant deaf, extremewy premature infants (wess dan 1,000 g, wess dan 28 weeks gestationaw age, or wess dan 35 cm in wengf) dat were born awive (breaded, had a heartbeat, or exhibited vowuntary muscwe movement) but faiwed to survive for at weast seven days.[75] Awdough such extremewy premature infants typicawwy accounted for onwy about 0.5% of aww wive-born chiwdren, deir excwusion from bof de numerator and de denominator in de reported IMR wed to an estimated 22%–25% wower reported IMR.[76] In some cases, too, perhaps because hospitaws or regionaw heawf departments were hewd accountabwe for wowering de IMR in deir catchment area, infant deads dat occurred in de 12f monf were "transferred" statisticawwy to de 13f monf (i.e., de second year of wife), and dus no wonger cwassified as an infant deaf.[77][78]

In certain ruraw devewoping areas, such as nordeastern Braziw, infant birds are often not recorded in de first pwace, resuwting in de discrepancies between de infant mortawity rate (IMR) and de actuaw amount of infant deads. Access to vitaw registry systems for infant birds and deads is an extremewy difficuwt and expensive task for poor parents wiving in ruraw areas. Government and bureaucracies tend to show an insensitivity to dese parents and deir recent suffering from a wost chiwd, and produce broad discwaimers in de IMR reports dat de information has not been properwy reported, resuwting in dese discrepancies. Littwe has been done to address de underwying structuraw probwems of de vitaw registry systems in respect to de wack of reporting from parents in ruraw areas, and in turn has created a gap between de officiaw and popuwar meanings of chiwd deaf.[46] It is awso argued dat de bureaucratic separation of vitaw deaf recording from cuwturaw deaf rituaws is to bwame for de inaccuracy of de infant mortawity rate (IMR). Vitaw deaf registries often faiw to recognize de cuwturaw impwications and importance of infant deads. It is not to be said dat vitaw registry systems are not an accurate representation of a region's socio-economic situation, but dis is onwy de case if dese statistics are vawid, which is unfortunatewy not awways de circumstance. "Popuwar deaf reporters" is an awternative medod for cowwecting and processing statistics on infant and chiwd mortawity. Many regions may benefit from "popuwar deaf reporters" who are cuwturawwy winked to infants may be abwe to provide more accurate statistics on de incidence of infant mortawity.[46] According to ednographic data, "popuwar deaf reporters" refers to peopwe who had inside knowwedge of anjinhos, incwuding de grave-digger, gatekeeper, midwife, popuwar heawers etc. —— aww key participants in mortuary rituaws.[46] By combining de medods of househowd surveys, vitaw registries, and asking "popuwar deaf reporters" dis can increase de vawidity of chiwd mortawity rates, but dere are many barriers dat can refwect de vawidity of our statistics of infant mortawity. One of dese barriers are powiticaw economic decisions. Numbers are exaggerated when internationaw funds are being dowed out; and underestimated during reewection, uh-hah-hah-hah.[46]

The bureaucratic separation of vitaw deaf reporting and cuwturaw deaf rituaws stems in part due to structuraw viowence.[79] Individuaws wiving in ruraw areas of Braziw need to invest warge capitaw for wodging and travew in order to report infant birf to a Braziwian Assistance League office. The negative financiaw aspects deters registration, as often individuaws are of wower income and cannot afford such expenses.[46] Simiwar to de wack of birf reporting, famiwies in ruraw Braziw face difficuwt choices based on awready existing structuraw arrangements when choosing to report infant mortawity. Financiaw constraints such as rewiance on food suppwementations may awso wead to skewed infant mortawity data.[46]

In devewoping countries such as Braziw de deads of impoverished infants are reguwarwy unrecorded into de countries vitaw registration system; dis causes a skew statisticawwy. Cuwturawwy vawidity and contextuaw soundness can be used to ground de meaning of mortawity from a statisticaw standpoint. In nordeast Braziw dey have accompwished dis standpoint whiwe conducting an ednographic study combined wif an awternative medod to survey infant mortawity.[46] These types of techniqwes can devewop qwawity ednographic data dat wiww uwtimatewy wead to a better portrayaw of de magnitude of infant mortawity in de region, uh-hah-hah-hah. Powiticaw economic reasons have been seen to skew de infant mortawity data in de past when governor Ceara devised his presidency campaign on reducing de infant mortawity rate during his term in office. By using dis new way of surveying, dese instances can be minimized and removed, overaww creating accurate and sound data.[46]

For de worwd, and for bof wess devewoped countries (LDCs) and more devewoped countries (MDCs), IMR decwined significantwy between 1960 and 2001. According to de State of de Worwd's Moders report by Save de Chiwdren, de worwd IMR decwined from 126 in 1960 to 57 in 2001.[81]

However, IMR was, and remains, higher in LDCs. In 2001, de IMR for LDCs (91) was about 10 times as warge as it was for MDCs (8). On average, for LDCs, de IMR is 17 times as higher dan dat of MDCs. Awso, whiwe bof LDCs and MDCs made significant reductions in infant mortawity rates, reductions among wess devewoped countries are, on average, much wess dan dose among de more devewoped countries.[cwarification needed]

A factor of about 67 separate countries wif de highest and wowest reported infant mortawity rates. The top and bottom five countries by dis measure (taken from The Worwd Factbook's 2012 estimates[82]) are shown bewow.

1906 headwine impworing parents to attend to de cweanwiness of deir infants, and to expose dem to de "cwean air" outdoors.

The infant mortawity rate in de US decreased by 2.3% to a historic wow of 582 infant deads per 100,000 wive birds in 2014.[84]

Of de 27 most devewoped countries, de U.S. has de highest Infant Mortawity Rate, despite spending much more on heawf care per capita[citation needed]. Significant raciaw and socio-economic differences in de United States affect de IMR, in contrast wif oder devewoped countries, which have more homogeneous popuwations. In particuwar, IMR varies greatwy by race in de US. The average IMR for de whowe country is derefore not a fair representation of de wide variations dat exist between segments of de popuwation, uh-hah-hah-hah. Many deories have been expwored as to why dese raciaw differences exist wif socio economic factors usuawwy coming out as a reasonabwe expwanation, uh-hah-hah-hah. However, more studies have been conducted around dis matter, and de wargest advancement is around de idea of stress and how it affects pregnancy.[85]

In de 1850s, de infant mortawity rate in de United States was estimated at 216.8 per 1,000 babies born for whites and 340.0 per 1,000 for African Americans, but rates have significantwy decwined in de West in modern times. This decwining rate has been mainwy due to modern improvements in basic heawf care, technowogy, and medicaw advances.[86] In de wast century, de infant mortawity rate has decreased by 93%.[16] Overaww, de rates have decreased drasticawwy from 20 deads in 1970 to 6.9 deads in 2003 (per every 1000 wive birds). In 2003, de weading causes of infant mortawity in de United States were congenitaw anomawies, disorders rewated to immaturity, SIDS, and maternaw compwications. Babies born wif wow birf weight increased to 8.1% whiwe cigarette smoking during pregnancy decwined to 10.2%. This refwected de amount of wow birf weights concwuding dat 12.4% of birds from smokers were wow birf weights compared wif 7.7% of such birds from non-smokers.[87] According to de New York Times, "de main reason for de high rate is preterm dewivery, and dere was a 10% increase in such birds from 2000 to 2006." Between 2007 and 2011, however, de preterm birf rate has decreased every year. In 2011 dere was a 11.73% rate of babies born before de 37f week of gestation, down from a high of 12.80% in 2006.[88]

Economic expenditures on wabor and dewivery and neonataw care are rewativewy high in de United States. A conventionaw birf averages 9,775 USD wif a C-section costing 15,041 USD.[89] Preterm birds in de US have been estimated to cost $51,600 per chiwd, wif a totaw yearwy cost of $26.2 biwwion, uh-hah-hah-hah.[90] Despite dis spending, severaw reports state dat infant mortawity rate in de United States is significantwy higher dan in oder devewoped nations.[15][91][92] Estimates vary; de CIA's Worwd Factbook ranks de US 55f internationawwy in 2014, wif a rate of 6.17, whiwe de UN figures from 2005-2010 pwace de US 34f.

Aforementioned differences in measurement couwd pway a substantiaw rowe in de disparity between de US and oder nations. A non-viabwe wive birf in de US couwd be registered as a stiwwbirf in simiwarwy devewoped nations wike Japan, Sweden, Norway, Irewand, de Nederwands, and France – dereby reducing de infant deaf count.[93] Neonataw intensive care is awso more wikewy to be appwied in de US to marginawwy viabwe infants, awdough such interventions have been found to increase bof costs and disabiwity. A study fowwowing de impwementation of de Born Awive Infant Protection Act of 2002 found universaw resuscitation of infants born between 20–23 weeks increased de neonataw spending burden by $313.3 miwwion whiwe simuwtaneouswy decreasing qwawity-adjusted wife years by 329.3.[94]

Data indicating de IMR disparity between infants Non-Hispanic bwack moders and infants of white or Hispanic moders in de United States from 2000-2010.

The vast majority of research conducted in de wate twentief and earwy twenty-first century indicates dat African-American infants are more dan twice as wikewy to die in deir first year of wife dan white infants. Awdough fowwowing a decwine from 13.63 to 11.46 deads per 1000 wive birds from 2005 to 2010, non-Hispanic bwack moders continued to report a rate 2.2 times as high as dat for non-Hispanic white moders.[95]

Contemporary research findings have demonstrated dat nationwide raciaw disparities in infant mortawity are winked to de experientiaw state of de moder and dat dese disparities cannot be totawwy accounted for by socio-economic, behavioraw or genetic factors.[15] The Hispanic paradox, an effect observed in oder heawf indicators, appears in de infant mortawity rate, as weww. Hispanic moders see an IMR comparabwe to non-Hispanic white moders, despite wower educationaw attainment and economic status. A study in Norf Carowina, for exampwe, concwuded dat "white women who did not compwete high schoow have a wower infant mortawity rate dan bwack cowwege graduates."[96] According to Mustiwwo's CARDIA (Coronary Artery Risk Devewopment in Young Aduwts) study, "sewf reported experiences of raciaw discrimination were associated wif pre-term and wow-birdweight dewiveries, and such experiences may contribute to bwack-white disparities in prenataw outcomes."[97] Likewise, dozens of popuwation-based studies indicate dat "de subjective, or perceived experience of raciaw discrimination is strongwy associated wif an increased risk of infant deaf and wif poor heawf prospects for future generations of African Americans."[15]

Whiwe earwier parts of dis articwe have addressed de raciaw differences in infant deads, a cwoser wook into de effects of raciaw differences widin de country is necessary to view discrepancies. Non-Hispanic Bwack women wead aww oder raciaw groups in IMR wif a rate of 11.3, whiwe de Infant Mortawity Rate among white women is 5.1.[98] Bwack women in de United States experience a shorter wife expectancy dan white women, so whiwe a higher IMR amongst bwack women is not necessariwy out of wine, it is stiww rader disturbing.[99] Whiwe de popuwar argument weads to de idea dat due to de trend of a wower socio-economic status had by bwack women dere is in an increased wikewihood of a chiwd suffering. Whiwe dis does correwate, de deory dat it is de contributing factor fawws apart when we wook at Latino IMR in de United States. Latino peopwe are awmost just as wikewy to experience poverty as bwacks in de U.S., however, de Infant Mortawity Rate of Latinos is much cwoser to white women dan it is to bwack women, uh-hah-hah-hah. The Poverty Rates of bwacks and Latinos are 24.1% and 21.4% respectivewy. If dere is a direct correwation, den de IMR of dese two groups shouwd be rader simiwar, however, bwacks have an IMR doubwe dat of Latinos.[100] Awso, as bwack women move out of poverty or never experienced it in de first pwace, deir IMR is not much wower dan deir counterparts experiencing higher wevews of poverty.

Some bewieve bwack women are predisposed to a higher IMR, meaning ancestrawwy speaking, aww bwack women from African descent shouwd experience an ewevated rate. This deory is qwickwy disproven by wooking at women of African descent who have immigrated to de United States. These women who come from a compwetewy different sociaw context are not prone to de incredibwy high IMR experienced by American-born bwack women, uh-hah-hah-hah.[101]

Tyan Parker Dominguez at de University of Soudern Cawifornia offers a deory to expwain de disproportionawwy high IMR among bwack women in de United States. She cwaims African American women experience stress at much higher rates dan any oder group in de country. Stress produces particuwar hormones dat induce wabor and contribute to oder pregnancy probwems. Considering earwy birds are one of de weading causes of deaf of infants under de age of one, induced wabor is a very wegitimate factor. The idea of stress spans socio-economic status as Parker Dominguez cwaims stress for wower-cwass women comes from unstabwe famiwy wife and chronic worry over poverty. For bwack middwe-cwass women, battwing racism, reaw or perceived, can be an extreme stressor.[102]

Strides have been made, however, to combat dis epidemic. In Los Angewes County, heawf officiaws have partnered wif non-profits around de city to hewp bwack women after de dewivery of deir chiwd. One non-profit in particuwar has made a warge impact on many wives is Great Beginnings For Bwack Babies in Ingwewood. The non-profit centers around hewping women deaw wif stress by forming support networks, keeping an open diawogue around race and famiwy wife, and awso finding dese women a secure pwace in de workforce.[104]

This section needs expansion. You can hewp by adding to it.(October 2016)

The weading causes of infant mortawity have changed over time. Unpasteurized miwk was de weading cause of infant mortawity wate in de 19f century.[105] Pasteurization of miwk cut infant mortawity by around 3/4.[105]